# A nurse is assessing a 72-year-old client with diabetic retinopathy who has been referred for evaluation of potential legal blindness. Which assessment finding would most accurately indicate that the client meets the criteria for legal blindness? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541551 > language: ko > subject: Adult Health ## 문제 A nurse is assessing a 72-year-old client with diabetic retinopathy who has been referred for evaluation of potential legal blindness. Which assessment finding would most accurately indicate that the client meets the criteria for legal blindness? Visual acuity assessment for legal blindness determination ## 보기 1. Visual acuity of 20/100 in the better eye with corrective lenses 2. Complete loss of peripheral vision with normal central vision 3. Visual acuity of 20/200 or worse in the better eye with best correction **✔ 정답** 4. Difficulty distinguishing colors and night blindness **정답: 3** ## 해설 Legal blindness is defined as visual acuity of 20/200 or worse in the better eye with best correction. Other options describe visual impairments that do not meet the specific legal criteria. ## 심화 해설 Understanding Legal Blindness in the NCLEX-RN Context The determination of legal blindness is a critical concept for nursing assessment, particularly when coordinating care and ensuring patient safety. While the term "legal blindness" is often misunderstood by the public as complete darkness, it is a specific, regulatory definition primarily based on a quantitative measure of central visual acuity or a qualitative measure of visual field restriction. The provided research by Wu et al. (2026) reinforces the standard acuity-based criterion by defining legal blindness as a visual acuity (VA) of 1 logMAR or 20/200 [1]. Analysis of the Correct Answer The correct answer is Option 3: Visual acuity of 20/200 or worse in the better eye with best correction. This finding aligns precisely with the core definition of legal blindness. The study explicitly states that its screening questions were designed to identify individuals who meet the "legal blindness as defined by the VA criterion (VA ≤ 1 logMAR or 20/200)" [1]. In clinical practice, this means that even with the most optimal refractive correction (glasses or contact lenses), the eye with the best possible vision can only see at 20 feet what a person with normal vision can see at 200 feet. This standard is crucial for determining eligibility for government disability benefits, vocational rehabilitation, and specialized low-vision services. Analysis of Incorrect Options - Option 1: Visual acuity of 20/100 in the better eye with corrective lenses. A visual acuity of 20/100 indicates reduced vision, but it does not meet the threshold for legal blindness. The research classifies this level of acuity within a broader category of "low vision," which it defines as VA ≤ 0.3 logMAR or 20/40 [1]. A client with 20/100 vision would be classified as having moderate low vision and would face significant functional challenges, but they would not be certified as legally blind based on this acuity score alone. - Option 2: Complete loss of peripheral vision with normal central vision. This option describes a visual field deficit, which is the second, separate pathway to a legal blindness diagnosis. While a visual field of 20 degrees or less in the better eye does constitute legal blindness, the question asks for the finding that would most accurately indicate the criteria are met based on the assessment of visual acuity. The study by Wu et al. specifically focuses on an "acuity-defined" criterion, making the numeric visual acuity measurement the most direct and accurate indicator in this context [1]. - Option 4: Difficulty distinguishing colors and night blindness. These symptoms are common functional consequences of diabetic retinopathy due to progressive damage to the retinal photoreceptors (rods for night vision, cones for color and detail). However, they are subjective, qualitative symptoms, not quantitative measures of legal blindness. A client can have severe night blindness and impaired color discrimination while still maintaining central visual acuity better than 20/200, and thus would not be classified as legally blind by the standard acuity definition used in the study [1]. Pathophysiology and Clinical Application for Diabetic Retinopathy In diabetic retinopathy, chronic hyperglycemia leads to microvascular damage in the retina. The pathological sequence involves pericyte loss, capillary basement membrane thickening, and endothelial cell damage, which cause capillary occlusion and retinal ischemia. This ischemia triggers an upregulation of vascular endothelial growth factor (VEGF), leading to proliferative diabetic retinopathy with fragile new vessel formation that can hemorrhage, cause tractional retinal detachment, and ultimately result in profound, irreversible vision loss. Macular edema, the leading cause of vision loss in diabetic retinopathy, occurs when fluid and lipid exudates accumulate in the central macula, directly destroying the high-acuity cones responsible for the sharp central vision measured by a Snellen chart. The nurse’s role is not just to identify the 20/200 threshold but to understand that this finding represents end-organ damage from a systemic disease, necessitating a holistic care plan that integrates strict glycemic control, blood pressure management, and safety interventions for a client with severely limited visual function [1].References (research sources) - [1]Screening Questions to Identify Low Vision and Acuity-Defined Legal Blindness.Research articleWu YH, Yu D, Goldstein J, Kwon M, Wang C, Legge GE. (2026) · DOI: 10.1167/iovs.67.1.28 ## 임상 시나리오 Determining Legal BlindnessKey Assessment Criteria for Nursing Practice The primary criterion for legal blindness is a best-corrected visual acuity of 20/200 or worse in the better eye. This means the client can see at 20 feet what a person with normal vision sees at 200 feet, even with optimal corrective lenses. An alternative criterion is a visual field restriction to 20 degrees or less in the better eye, often described as tunnel vision. A patient can meet the definition through either the acuity or the visual field standard. CautionAlways document that the acuity measurement was taken with best correction. Uncorrected acuity is not used for this determination. This status is essential for coordinating disability services, low-vision rehabilitation, and ensuring patient safety. ## 핵심 개념 - **Legal Blindness** — A regulatory definition for disability benefits, primarily based on best-corrected central visual acuity of 20/200 or worse in the better eye, or a visual field of 20 degrees or less. - **Visual Acuity** — A quantitative measure of the eye's ability to distinguish shapes and details at a given distance, typically assessed using a Snellen chart. - **Best Correction** — The sharpest vision achievable with the use of corrective lenses (glasses or contact lenses) as determined during a refractive examination. - **Diabetic Retinopathy** — A microvascular complication of diabetes mellitus causing damage to the retinal blood vessels, which can lead to vision impairment and is a leading cause of legal blindness. - **LogMAR** — Logarithm of the Minimum Angle of Resolution; a standardized scale for measuring visual acuity where a score of 1.0 is equivalent to 20/200 Snellen acuity. ## 같은 주제 문제 - [A nurse is assessing a 68-year-old client who has been referred for evaluation of potentia…](https://mymerci.kr/pages/nclex_q.php?qn_id=541552) - [A nurse is conducting an initial assessment of a 45-year-old client who was recently diagn…](https://mymerci.kr/pages/nclex_q.php?qn_id=541553) - [A nurse is caring for a 72-year-old client with diabetic retinopathy who has been declared…](https://mymerci.kr/pages/nclex_q.php?qn_id=541554) - [A nurse is caring for a client who has been diagnosed with legal blindness. 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